Healthcare Provider Details

I. General information

NPI: 1821468448
Provider Name (Legal Business Name): PEGGY A. KNOWLES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SE 177TH AVE
VANCOUVER WA
98683-4201
US

IV. Provider business mailing address

PO BOX 728
CAMAS WA
98607-0728
US

V. Phone/Fax

Practice location:
  • Phone: 360-980-2441
  • Fax: 877-491-4990
Mailing address:
  • Phone: 360-980-2441
  • Fax: 877-491-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60605303
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60511802
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: